外阴癌新辅助化疗进展

局部晚期外阴癌患者的处理较为棘手。近年来针对这部分患者进行新辅助化疗后行手术治疗的研究显示,以博来霉素和铂类药物为主的多种化疗方案反应率较好,不良反应可耐受。化疗2~3个疗程后手术,可缩小手术范围,保留器官功能,提高生存率。但仍需更深入的研究评价其效果及最佳治疗方案。     

Laparoscopic microsurgery: current and future status.

The successful introduction of microsuturing and microinstruments for operative laparoscopy has allowed the convergence of laparoscopy and traditional microsurgery, resulting in the evolution of the 'new microsurgery'. This more dynamic approach overcomes the limitations of open microsurgery by providing continuous magnification and the benefits of a closed environment, making laparoscopy a complete surgical tool. The test model for microsurgery is tubal anastomosis, which is very dependent on operative technique to attain well-established pregnancy rates. Our cumulative pregnancy results for laparoscopic microsurgical tubal anastomosis of 76% at 12 months, 70% at 9 months, 67% at 6 months and 44% at 3 months, compares favorably to the best results achieved by traditional open microsurgery. With this validation the technique is now employed as a complete solution for all tubal surgery. The ability to effect microsurgical repair of the ureter, bladder, bowel and vessels has expanded the surgical repertoire, allowing radical excision of deep endometriosis, severe enterolysis, and adhesiolysis.     

Chemoprevention of breast cancer: a literature review and report on the current status in Germany

The prevention of breast cancer is increasingly of focus in health-politics policies and has gained a valid position in the area of medical intervention. Data from a current meta-analysis of all four randomised Tamoxifen prevention studies illustrate a reduction of 38 % (Odds ratio 0.62; 95 % CI 0.42-0.89) in the incidence of breast cancer. This observation lead to registration of this drug in the USA for the prevention of breast cancer in women with a calculated 5-year risk of > 1.66 %. In addition to Tamoxifen, further substances are currently being tested with the aim of improving the therapeutic index whilst reducing incidence and mortality rates. These are primarily substances which have proven efficacy in the treatment of breast cancer (other antioestrogens, aromatase inhibitors and GnRH-analogues) or those whose mechanism of action predict a preventative effect (retinoids, phytooestrogens, substitution preparations e. g. Tibolone). In Germany, chemoprevention is currently only to be recommended within study protocols, as to date no substance is approved in the indication 'prevention of breast cancer'. A essential contribution to the accrual of valid data is the conduct of breast cancer prevention trials. The participation of women with high risk of breast cancer in Germany is, in contrast to comparable international studies, problematic. Data on the current knowledge and attitude of the female population towards such trials (gathered via a questionnaire of the DACH in 7 000 women) show that only 19.5 % of the women questioned during a consultation with a gynaecologist were aware of the possibility of active chemoprevention. However, 55.3 % stated that they would be prepared to take such a substance, were chemoprevention possible. Studies for both pre- and post-menopausal women with increased risk of breast cancer are currently active in Germany (GISS and IBIS-II of the study group GABG - German Adjuvant Breast cancer Group). An intensive information campaign to raise public awareness of breast cancer risk amongst women and their physicians is planned in conjunction with the IBIS-II study (www.brustkrebsvorbeugen.de). Latest literature recommendations for prevention of breast cancer (Chlebowski et al.) have been assessed.     

The gynecologist and the melanoma: breast and endometrial metastases

Melanoma has an important metastatic potential and its incidence is greatly increasing. Even after many years of negative follow-up, gynecologists should be aware that a gynecological tumor might be a secondary location for a woman with a medical history of melanoma. Because of a poor prognosis and a reduced life expectancy, it is necessary to make a disease staging in order to offer a prompt diagnosis and a personalized strategy of treatment. Considering the increasing incidence of melanoma, gynecologists will face more frequently with this situation.     

Ovarian cancer: current management and future directions

Of all the gynaecological malignancies ovarian cancer has the highest mortality. Different types of ovarian cancer vary significantly in their clinical and molecular characteristics and Epithelial ovarian cancer (EOC) is the most common subtype. Up to 20% of women with epithelial ovarian cancer have an inherited predisposition. The fallopian tubes are a potential source of high-grade serous cancer and risk reducing surgery can be an option. Routine screening with serum CA 125 and pelvic ultrasonography is still unproven. Diagnosis of ovarian tumours is usually made by pelvic ultrasonography and serum CA 125. The risk of malignancy index (RMI) is then calculated in order to decide where treatment takes place. Treatment of advanced ovarian cancer usually involves primary debulking surgery and adjuvant chemotherapy but neo-adjuvant chemotherapy with interval debulking surgery is equally effective. Survival is improved if surgery is performed by a specialist gynaecological oncologist. Recent evidence supports the value of radical surgery aiming to excise all macroscopic disease. Standard first line chemotherapy for epithelial ovarian cancer remains carboplatin with paclitaxel. BRAC mutation testing is frequently used to direct second line chemotherapy and molecular targeted treatments such as bevacizumab and PARP inhibitors have been added to the armoury against ovarian cancer. Treatment of advanced disease may prolong life and palliate symptoms but it is rarely curative. Novel drugs and approaches such as ultra-radical surgery, intra-peritoneal chemotherapy, and surgery for recurrent disease are being assessed.     

Ovarian cancer: current management and future directions

Ovarian cancer has the highest mortality of all the gynaecological malignancies. Epithelial ovarian cancer is the most common subtype. Approximately 5–10% occur in women with an inherited predisposition. These patients may benefit from prophylactic surgery. Diagnosis involves measurement of CA 125 and ultrasound. The results of both are combined to give a risk of malignancy index; this is used to decide where treatment takes place. Treatment of advanced epithelial ovarian cancer usually involves debulking surgery and chemotherapy. The correct order of these treatments is currently being evaluated. There are survival benefits if surgery is performed by a specialist gynaecological oncologist. Current standard chemotherapy for epithelial ovarian cancer is carboplatin with paclitaxel. Treatment may prolong life and palliate symptoms but it is rarely curative. New treatments are constantly being developed and offer the hope of improved outcomes. These include ultraradical surgery, intraperitoneal chemotherapy and novel drug treatments.     

植入前遗传学诊断的研究现状及展望

遗传性疾病已经成为威胁人类健康的主要疾病之一。在没有找到一种有效的治疗方法之前 ,用产前诊断技术预防遗传病患儿的出生 ,是达到减少乃至杜绝遗传病发生的主要途径。本世纪 6 0年代以来 ,羊膜腔穿刺技术、绒毛膜取样技术已经常规地应用于围产儿监测 ,有效地减少了遗传病患儿的出生 ,同时产前诊断技术本身也得到了不断的发展 ,主要表现在两个方面 :无创性产前诊断及植入前遗传学诊断 (ｐｒｅｉｍｐｌａｎｔａｔｉｏｎｇｅｎｅｔｉｃｄｉａｇｎｏｓｉｓ ,ＰＧＤ )。ＰＧＤ指对配子或移入到子宫腔之前的胚胎进行遗传学分析 ,去除有遗传缺陷…     

Ovarian cancer screening in the general population: current status

Abstract. Menon U, Jacobs IJ. Ovarian cancer screening in the general population: current status.
There has been considerable interest in the prospect of early detection of ovarian cancer through screening asymptomatic women from the general population. The results of recently published trials provide encouraging data on the possible impact on mortality. There are, however, concerns about compliance, cost, and morbidity from surgery for false positive screen results. The two ongoing randomized controlled trials in the US and UK aim to establish definitively the true impact of screening on ovarian cancer mortality while comprehensively tackling the issues of target population, compliance, health economics, and physical and psychological morbidity of screening.     

Ovarian cancer screening: Current status and future directions

Ovarian cancer is the third most common gynaecological malignancy and the most lethal worldwide. Most patients are diagnosed with advanced disease which carries significant mortality. Improvements in treatment have only resulted in modest increases in survival. This has driven efforts to reduce mortality through screening. Multimodal ovarian cancer screening using a longitudinal CA125 algorithm has resulted in diagnosis at an earlier stage, both in average and high risk women in two large UK trials. However, no randomised controlled trial has demonstrated a definitive mortality benefit. Extended follow up is underway in the largest trial to date, UKCTOCS, to explore the delayed reduction in mortality that was noted. Meanwhile, screening is not currently recommended in the general population Some countries offer surveillance of high risk women. Novel screening modalities and longitudinal biomarker algorithms offer potential improvements to future screening strategies as does the development of better risk stratification tools.     

Nutrition and primary prevention of breast cancer: foods, nutrients and breast cancer risk

Worldwide, each year approximately one million women are newly diagnosed with breast cancer (BC), in Germany 65 new cases per 100,000 inhabitants are registered, yearly. The fact that incidence has been rising in parallel with economic development indicates that environmental factors might play a role in the causation of BC. Migrational data have pointed to nutrition as one of the more relevant external factors involved. Preventive dietary advice often includes a reduction of alcohol, red meat and animal fat and increasing the intake of vegetables, fruit and fibre and lately, phyto-estrogens from various sources. Clearly, the scientific basis for these recommendations appears sparse. The available prospective data from epidemiological studies and interventional trials do not support the overall hypothesis that higher fat-intakes are a relevant risk factor for BC development, more important seems the relative distribution of various fatty acids. A non-vegetarian eating habit (consumption of animal products) per se does not elevate BC risk, while consumption of broiled or deep fried meats cannot be ruled out as a risk factor in genetically susceptible individuals. It appears prudent to abstain from regular and increased alcohol consumption. This should be particularly true for pubescent girls, in whom glandular breast tissue is particularly vulnerable. In general, if alcohol is consumed on a regular basis, a sufficient supply of fresh vegetables and fruit is essential. While there is no overall protective effect of a high fruit and vegetable consumption speculation remains over possible beneficial effects of certain subcategories, especially brassica vegetables like broccoli, cauliflower and cabbage. In essence, regional differences in BC incidence are probably partially attributable to life long dietary habits. There is no need to adopt a foreign dietary plan in order to protect oneself against BC. Traditional western diets also have their beneficial ingredients that should be regular constituents in our meals. Lignans from traditionally made sourdough rye bread, linseed/flaxseed and berries are local sources of potentially canceroprotective phyto-estrogens. Furthermore, indole-3-carbinol rich cabbage species might contribute to BC protection by diet. Nevertheless, clear cut recommendations for or against single nutrients or secondary plant metabolites are not yet possible, lacking sufficient data on individual bioavailability, safety and long term outcome. BC prevention by dietary means therefore relies on an individually tailored mixed diet, rich in basic foods and traditional manufacturing and cooking methods.